Burnout and patient engagement

© freshidea - stock.adobe.com

Physician burnout, the trend of doctors feeling tired and frustrated due to their work, has been a growing issue for several years. According to recent figures from the American Medical Association, almost two-thirds of doctors (63%) say that they are experiencing symptoms of burnout. This is an issue that has been building over the past few decades, but we have undoubtedly seen growth in recent years, first with the advent of electronic medical records, and more recently, fueled by the pandemic.

Jaded feelings, lack of self-care and less quality time spent with friends and family – all typical symptoms of doctor burnout, are detrimental to anyone’s health. This issue becomes even more critical due to the potential spillover effect on patient care.

Despite seeing and experiencing this trend and knowing that we would eventually reach these levels of doctor burnout, it is still shocking and surprising. The enthusiasm with which graduates from medical school enter the workforce is diminishing. Many of the motivations for doctors starting out two decades ago, including helping to heal and cure patients’ illnesses and developing a doctor-patient relationship, are now weaker. This is in part because doctors have been made to cede control to administrators focused on maximizing profits; in addition, doctors are now tasked with reaching unrealistic patient volume targets, removing the more personal, human aspect of practicing medicine.

One of the critical turning points in the last 10 years has been the introduction of Electronic Medical Records (EMR). EMRs were not primarily designed to help doctors or patients, instead they were built for compliance, billing, and record keeping. The clunky user interfaces and excessive documentation requirements of these systems have forced doctors to work many additional hours in the evenings and on weekends, which they are not paid to do, and which interferes with their ability to have balanced lives.

Daily issue of burnout

Beyond these macro issues, physicians also face a daily struggle that contributes to burnout. Over half of the US population have at least one chronic condition, as a result, a doctor will, on average, see multiple patients a day with chronic conditions. Since doctors have to hit volume targets to satisfy their hospital or practice employers, time available to spend with each patient shrinks. This leads many doctors to see the same patients repeatedly in order to have time to address all of their complex issues. At the most extreme, doctors can see the same patient on a bi-weekly or monthly basis. While this clearly places a burden on patients, it is also far from optimal for doctors. Doctors can feel pressured by both seeing the same patients repeatedly and having less time to treat others, all of which contributes to burnout.

Beyond the extra workload of appointments, treatment of patients with chronic conditions adds both physical and emotional burdens. Patients with multiple conditions have to take as many as six or seven medications at once. This requires doctors to spend time explaining how the medication works, best way to administer and cadence of administration. Over time, care for a patient with chronic conditions also involves blood pressure checks, cholesterol readings, performing A1C checks, accurate weighing at the clinic and helping the patient to establish a healthy lifestyle incorporating a balanced diet and regular exercise. While these extra steps of care are feasible for a single patient, at the current scale of chronic condition sufferers this workload becomes unmanageable and is only set to get worse.

Other health factors beyond the patient’s chronic conditions also play a role. If a patient gets the flu or is unable to manage their diabetes due to another condition this can cause setbacks in treatment. Furthermore, as a general rule the older a patient gets the more conditions they develop, with time this becomes increasingly difficult. As an example, older patients may be looked after by a family member or care giver who needs to be informed about all medical and health treatment decisions. If the family member is not always present to help administer medication this can lead to issues with adherence. Meanwhile, patients with Alzheimer’s or Dementia face issues with remembering to take medication or to stick to other elements of their treatment plan such as exercise or diet. As our population ages and the prevalence of chronic conditions increases, the burden of treating these patients will continue to rise.

As many as half of patients do not adhere to the treatment regimens prescribed by their physician. There are many reasons why patients do not adhere, from lack of understanding the importance, to distrust of the medical community in general, to fear of side effects, and more. When physicians put their energy and heart into caring for their patients, witnessing repetitive non-adherence and the consequential detriment to the patient’s health, can have an outsized emotional impact on doctors, and contributes to emotional burnout.

The potential of patient engagement

We often forget that patients with chronic conditions not only need to exercise regularly and eat a healthy diet but also must manage this alongside any other struggles in their day-to-day life. So, it should be no surprise that they do not always adhere to their treatment programs. Patient engagement platforms provide a solution for this through support for patients in adhering to their treatment and medication. These solutions can act as an extension of the doctor’s recommendations, lessening reliance on precious doctor time and reducing physician burnout.

Patient engagement platforms cannot solve the burnout problem in its entirety. However, they can reduce the burden on physicians. These platforms can act as a support mechanism for patients between appointments, an extension of the prescribed treatment plan, a means of increasing adherence, and as a trusted voice and partner in the patient’s health journey.But before we can herald the end of physician burnout there are key criteria that patient engagement platforms need to fulfil.

Prior to widespread acceptance of a digital health application, physicians need to see robust clinical validation. If a platform or application can demonstrably improve a patient’s outcomes and health, then it can and will find a place in a doctor’s toolbox and will help decrease burnout. Similarly, applications need to be physician-friendly, offering clinically actionable data on a regular but digestible basis. Through work with physicians to refine the application and its processes, patient engagement platforms can meet these criteria and thus offer a solution that reduces physician burnout.

Dr. Jennifer Meller, MD, is the chief medical officer at Sweetch, a precision engagement platform for patients with chronic conditions. A family doctor for 20 years in New York, she has first-hand experience treating patients with chronic conditions